How Long Is Methadone Treatment?

Methadone is a prescription opioid medication used in treating chronic pain and opioid addiction. It is classified as Schedule II controlled substance, which means that its use can result in physical and psychological dependence and that it has a high potential for abuse.¹

According to official statistics from 2018, around 256,000 people in the U.S. misused methadone in the past year. When it comes to overdose, although the number of methadone overdose deaths is not high compared to some other prescription drugs, methadone was involved in 2,611 interventions, as reported by the American Association for Poison Control Centers (AAPCC).²

Despite knowing the risks of methadone abuse and addiction, quitting methadone can entail some very unpleasant withdrawal symptoms, which can pose a challenge that a person cannot overcome without professional assistance.³ Treatment for methadone addiction can help the person safely detox and restore a healthy lifestyle. The dynamics and length of methadone treatment will depend on the particular case.

Methadone Use, Frequency & Length

When used to treat chronic pain, methadone may be taken every 8 to 12 hours.⁴ When methadone is used in addiction treatment, the dosage, schedule, and length of methadone treatment will depend on the condition of the particular patient, but it may last as long as it is necessary to ensure substantial improvement and abstinence.⁵

While methadone used for pain relief can be prescribed by any registered physician, methadone used in addiction treatment can only be dispensed through the opioid treatment programs certified by Substance Abuse and Mental Health Service Administration.⁶

There are several generic versions of methadone and it is relatively inexpensive compared to other prescription painkillers.⁷ When used in addiction treatment, methadone treatment is cost-effective, especially taking into consideration the healthcare and societal costs of substance abuse.⁸

How Long Is Methadone Withdrawal During Treatment?

In general, methadone treatment may start with medically supervised detoxification. This process may last from a couple of weeks to six months.³

If methadone use is stopped abruptly, the person will experience unpleasant withdrawal symptoms, which usually appear 24-36 hours after taking the last dose of the drug. The symptoms may at first resemble the ones of the flu, such as sweating, tiredness, or runny nose. However, when they peak, they can be more severe and include:³

• Muscle pain and cramps.
• Nausea, vomiting, diarrhea.
• Goosebumps.
• Depression.
• Drug cravings.

In case it is decided to cease methadone use abruptly, patients are usually prescribed medications that help in managing withdrawal symptoms.⁹

Tapering & Length of Methadone Treatment

Since these withdrawal symptoms can cause too much distress, there is a risk that the person will go back to abusing the drug to get relief. In such cases, a better option may be to reduce the dose of methadone gradually, which is referred to as tapering. The length of methadone treatment can be prolonged by keeping the person at the same lowered dose for a long time, but this ensures stability in treatment.9

Gradual dose reduction does not mean that the person will not experience any withdrawal symptoms. These symptoms intensify when the dose of methadone falls under 20 mg/day, peaking two or three days after complete cessation of methadone ingestion. How long they will be present depends on the duration of the taper.9

In general, people are more likely to stay abstinent if they do not have any mental health issues and are more functional in their private, social, and professional lives.9 A personalized aftercare plan is an important part of maintaining abstinence. One of the principles of effective addiction treatment is to include behavioral counseling in the treatment plan and help the patient recover not only physically but also psychologically.10

Length of Methadone Treatment: Inpatient & Outpatient

As it is the case with other addictions, there is no predetermined length of treatment and adjustments based on continuous assessment.¹¹ According to the Principles of Effective Treatment of the National Institute of Drug Abuse, treatment retention of 3 months or longer is generally expected to have better outcomes.¹⁰

In addition, a longer period of post-treatment abstinence tends to correlate with a lower chance of relapse later on. Data shows that almost 90% of those who are abstinent for two years are also abstinent 10 years later.¹²

The choice between an outpatient or an inpatient treatment plan depends on the level of care that the patient needs based on their health condition and the level of support that they have in their environment. If the patient is suffering from some co-occurring disorders they may need constant medical supervision during detox. Later on, the person may transition to outpatient care.13 For instance, the length of methadone treatment in intensive outpatient may last from 12 to 16 weeks.14

On the other hand, in some programs where methadone is used as maintenance therapy, the length of methadone treatment is typically at least 12 months. Some patients may even continue this type of treatment for years.¹⁰

What Affects the Length of Methadone Treatment?

The length of methadone treatment is affected by the rate of dose reduction. Since outpatient and inpatient substance abuse treatment using methadone usually involves gradual dose reduction, it is recommended that the rate of reduction is agreed to by the patient and that changes in reduction are not made more often than once a week.9 Even after the person stops using methadone, supportive care should be offered for at least 6 more months.7